{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:07:36Z","timestamp":1786118856481,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T00:00:00Z","timestamp":1709769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Descemet membrane endothelial keratoplasty (DMEK) is commonly used to treat endothelial pathologies in bicameral pseudophakic eyes with a normal depth of the anterior chamber. However, performing this procedure on eyes that have undergone vitrectomy carries a higher risk of complications. Therefore, this report presents a novel technique for improving the unfolding of a DMEK graft in a vitrectomized eye.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Presentation of case:<\/jats:title>\n                    <jats:p>A 49-year-old man with a history of complicated cataract surgery one year prior was referred to our clinic with pseudophakic bullous keratopathy in his left eye. The surgery involved a posterior capsular rupture, anterior vitrectomy, and implantation of a sulcus three-piece intraocular lens. DMEK and anterior vitrectomy were performed. However, the conventional tap technique was unsuccessful in unfolding the DMEK graft, owing to intraoperative hypotony and an inability to flatten the anterior chamber.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>To minimize excessive manipulation of the donor tissue, a 27-gauge cannula attached to a 3-cc syringe was used. A cannula was introduced through paracentesis near the edge of an unfolded DMEK graft. We then created a suction force by pulling back the plunger while slowly moving the needle backward during the graft unfolding. The postoperative course was uneventful, with a clear and fully attached DMEK graft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This technique reduces the complexity of DMEK graft unfolding in vitrectomized eyes, enabling easier and more controlled unfolding. However, further research with larger patient populations is required to determine the clinical relevance of this method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.109491","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T12:55:20Z","timestamp":1710507320000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Novel technique to improves graft unfolding in vitrectomized eyes during Descemet membrane endothelial keratoplasty"],"prefix":"10.1097","volume":"117","author":[{"given":"Majed","family":"Alkharashi","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"Otaif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-34-20260423","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1038\/eye.2008.393","article-title":"Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases","volume":"23","author":"L.","year":"2009","journal-title":"Eye"},{"key":"R2-34-20260423","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/1120672118757431","article-title":"DMEK versus DSAEK for Fuchs' endothelial dystrophy: a meta-analysis","volume":"29","author":"Marques,","year":"2019","journal-title":"Eur. J. Ophthalmol."},{"key":"R3-34-20260423","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1007\/s10792-021-01797-y","article-title":"Descemet membrane endothelial keratoplasty in vitrectomized eyes: a case series of outcomes and complications","volume":"41","author":"Phylactou,","year":"2021","journal-title":"Int. Ophthalmol."},{"key":"R4-34-20260423","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ICO.0000000000000288","article-title":"Descemet membrane endothelial keratoplasty in vitrectomized eyes: clinical results","volume":"34","author":"Yoeruek,","year":"2015","journal-title":"Cornea"},{"key":"R5-34-20260423","first-page":"390","article-title":"Descemet-membrane endothelial keratoplasty in patients with retinal comorbidity-a prospective cohort study","volume":"9","author":"Spaniol,","year":"2016","journal-title":"Int. J. Ophthalmol."},{"issue":"5","key":"R6-34-20260423","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi,","year":"2023","journal-title":"Int J Surg Lond Engl."},{"key":"R7-34-20260423","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/ICO.0000000000001072","article-title":"Enhancing Descemet membrane endothelial keratoplasty in postvitrectomy eyes with the use of pars plana infusion","volume":"36","author":"Sorkin,","year":"2017","journal-title":"Cornea"},{"key":"R8-34-20260423","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/ICO.0000000000001606","article-title":"Double-bubble technique in descemet membrane endothelial keratoplasty for vitrectomized eyes: a case series","volume":"37","author":"Hayashi,","year":"2018","journal-title":"Cornea"},{"key":"R9-34-20260423","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1097\/ICO.0000000000001614","article-title":"Novel technique for improving graft unfolding in vitrectomized eyes using a temporary diaphragm in descemet membrane endothelial keratoplasty","volume":"37","author":"Yoeruek,","year":"2018","journal-title":"Cornea"},{"key":"R10-34-20260423","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1097\/ICO.0000000000002024","article-title":"C-press technique to facilitate Descemet membrane endothelial keratoplasty surgery in vitrectomized patients: a case series","volume":"38","author":"Saad,","year":"2019","journal-title":"Cornea"}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261224002724?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261224002724?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ovid.com\/10.1016\/j.ijscr.2024.109491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T16:53:31Z","timestamp":1786035211000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1016\/j.ijscr.2024.109491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":10,"journal-issue":{"issue":"C","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1016\/j.ijscr.2024.109491","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"print"}],"subject":[],"published":{"date-parts":[[2024,4]]},"assertion":[{"value":"2024-02-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}